THE USE OF TIRZEPATIDE AND ITS IMPLICATIONS FOR PATIENTS UNDERGOING ANESTHESIA OR DEEP SEDATION
DOI:
https://doi.org/10.63330/aurumpub.036-029Keywords:
Tirzepatide, Anesthesia, Gastric emptying, Pulmonary aspiration, GLP-1Abstract
Tirzepatide is a dual agonist of glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors, widely used in the treatment of type 2 diabetes mellitus and obesity. Its mechanism of action includes increased glucose-dependent insulin secretion, reduced glucagon secretion, and delayed gastric emptying. This latter pharmacological effect has relevant implications in the perioperative context, especially in patients undergoing general anesthesia or deep sedation. Recent evidence suggests that delayed gastric emptying can result in the presence of residual gastric contents even after adequate fasting, increasing the risk of regurgitation and pulmonary aspiration during anesthetic procedures. This article reviews the pathophysiological mechanisms involved, the available clinical evidence, current recommendations from anesthesiological societies, and perioperative management strategies for patients using tirzepatide.
Downloads
References
HO, C. N.; AYERS, A. T.; KOHN, M. A.; UMPIERREZ, G. E.; KLONOFF, D. C. Glucagon-like peptide-1 receptor agonists and peri-procedural aspiration risk. Journal of the Endocrine Society, v. 9, n. 9, 2025.
NAUCK, M. A.; QUAST, D. R.; WEFERS, J.; MEIER, J. J. GLP-1 receptor agonists in the treatment of type 2 diabetes – state of the art. Molecular Metabolism, v. 46, 2021.
FRIAS, J. P. et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. The New England Journal of Medicine, v. 385, p. 503-515, 2021.
JASTREBOFF, A. M. et al. Tirzepatide once weekly for the treatment of obesity. The New England Journal of Medicine, v. 387, p. 205-216, 2022.
MORAN, C.; HINSON, J.; KALRA, S. Perioperative considerations in patients treated with GLP-1 receptor agonists. Anaesthesia, v. 79, 2024.
KUMAR, A.; THOMAS, M. Gastrointestinal effects of incretin-based therapies and implications for anesthesia. Current Opinion in Anaesthesiology, v. 36, n. 4, 2023.
SOCIETY FOR PERIOPERATIVE ASSESSMENT AND QUALITY IMPROVEMENT. Perioperative management of patients receiving GLP-1 receptor agonists: consensus recommendations. 2025.
FOOD AND DRUG ADMINISTRATION (FDA). Labeling update for GLP-1 receptor agonists regarding pulmonary aspiration risk during anesthesia. Silver Spring: FDA, 2024.
MELVIN, W. S.; GOLDBERG, P. A. Management of diabetic medications in the perioperative period. Anesthesiology Clinics, v. 38, n. 4, p. 753-765, 2020.
VAN OOSTENBRUGGE, R.; DE HEER, P. Preoperative fasting guidelines and gastric emptying in patients using incretin therapies. British Journal of Anaesthesia, v. 132, n. 1, 2024.
MIZUBUTI, G. B.; OPREA, A. D. Perioperative implications of GLP-1 receptor agonists. Anesthesia & Analgesia, v. 139, n. 2, 2024.
THOMPSON, A. M.; JONES, K. L. Drug-induced gastroparesis and anesthetic risk. Journal of Clinical Anesthesia, v. 77, 2022.
MULLER, T. D. et al. The incretin system and obesity pharmacotherapy. Nature Reviews Endocrinology, v. 18, p. 387-401, 2022.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
